Epidemiology of nosocomial Staphylococcus epidermidis and Acinetobacter baumannii infections in a neonatal intensive care unit
Abstract
Background and Objectives: This study aimed to investigate epidemiology of Staphylococcus epidermidis (S. epidermidis) and Acinetobacter baumannii (A. baumannii) infections in neonatal intensive care unit (NICU) in a period of 8 years.
Materials and Methods: This retrospective cohort study was conducted on 46 cases of nosocomial infection by S. epidermidis, and 44 neonates with A. baumannii in NICU of Valiasr hospital, Iran.
Results: The trend of A. baumannii and S. epidermidis infection were as follows: 1 and 7 in 2014, 11 and 7 in 2015, 20 and 11 in 2016, 1 and 4 in 2017, 4 and 6 in 2018, 4 and 4 in 2019, 0 and 1 in 2020, and 3 and 6 in 2021-March 2022 respectively. Mortality proportion (%) in neonates with S. epidermidis and A. baumannii infection was at 8.3 and 32.1, respectively. There was a strong positive correlation between number of infected neonates in month and average of prescribed antibiotics before incidence of infection in every baby in that month. Fluconazole prescription before incidence of infection were associated with the A. baumannii infection in month too. Amikacin prescription had adjusted correlation on increasing of A. baumannii and S. epidermidis infection in month.
Conclusion: It seems reducing of hospitalization duration and medication prescriptions management plays an important role in reducing of nosocomial infections.
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16. Ulu-Kilic A, Gundogdu A, Cevahir F, Kilic H, Gunes T, Alp E. An outbreak of bloodstream infection due to extensively resistant Acinetobacter baumannii among neonates. Am J Infect Control 2018; 46: 154-158.
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18. Peleg AY, Hooper DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 2010; 362: 1804-1813.
19. Lee H-Y, Hsu S-Y, Hsu J-F, Chen C-L, Wang Y-H, Chiu C-H. Risk factors and molecular epidemiology of Acinetobacter baumannii bacteremia in neonates. J Microbiol Immunol Infect 2017; 51: 367-376.
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23. Kilic A, Li H, Mellmann A, Basustaoglu AC, Kul M, Senses Z, et al. Acinetobacter septicus sp. nov. association with a nosocomial outbreak of bacteremia in a neonatal intensive care unit. J Clin Microbiol 2008; 46: 902-908.
24. Wang Y, Ren J, Yao Z, Wang W, Wang S, Duan J, et al. Clinical impact and risk factors of intensive care unit-acquired nosocomial infection: a propensity score-matching study from 2018 to 2020 in a teaching Hospital in China. Infect Drug Resist 2023; 16: 569-579.
25. Auriti C, Maccallini A, Di Liso G, Di Ciommo V, Ronchetti MP, Orzalesi M. Risk factors for nosocomial infections in a neonatal intensive-care unit. J Hosp Infect 2003; 53: 25-30.
26. Nagata E, Brito AS, Matsuo T. Nosocomial infections in a neonatal intensive care unit: incidence and risk factors. Am J Infect Control 2002; 30: 26-31.
27. Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet 2005; 365: 1175-1188.
28. Touati A, Achour W, Cherif A, Ben Hmida H, Afif FB, Jabnoun S, et al. Outbreak of Acinetobacter baumannii in a neonatal intensive care unit: antimicrobial susceptibility and genotyping analysis. Ann Epidemiol 2009; 19: 372-378.
29. Chen L-K, Kuo S-C, Chang K-C, Cheng C-C, Yu P-Y, Chang C-H, et al. Clinical antibiotic-resistant Acinetobacter baumannii strains with higher susceptibility to environmental phages than antibiotic-sensitive strains. Sci Rep 2017; 7: 6319.
30. Meyer E, Gastmeier P, Deja M, Schwab F. Antibiotic consumption and resistance: data from Europe and Germany. Int J Med Microbiol 2013; 303: 388-395.
31. Manzoni P, Arisio R, Mostert M, Leonessa M, Farina D, Latino MA, et al. Prophylactic fluconazole is effective in preventing fungal colonization and fungal systemic infections in preterm neonates: a single-center, 6-year, retrospective cohort study. Pediatrics 2006; 117(1): e22-32.
32. Austin N, Cleminson J, Darlow BA, McGuire W. Prophylactic oral/topical non‐absorbed antifungal agents to prevent invasive fungal infection in very low birth weight infants. Cochrane Database Syst Rev 2015; 2015: CD003478.
2. Aberg E, Ottosson A, Granlund M, Saeedi B, Stamm C, Brune T, et al. Harbouring group B streptococci in a neonatal intensive care unit led to an outbreak among preterm infants. Acta Paediatr 2019; 108: 58-61.
3. Ben Saida N, Ferjeni A, Benhadjtaher N, Monastiri K, Boukadida J. Clonality of clinical methicillin-resistant Staphylococcus epidermidis isolates in a neonatal intensive care unit. Pathol Biol (Paris) 2006; 54: 337-342.
4. Williams K, Hopkins S, Turbitt D, Seng C, Cookson B, Patel BC, et al. Survey of neonatal unit outbreaks in North London: identifying causes and risk factors. J Hosp Infect 2014; 88: 149-155.
5. Johnson J, Quach C. Outbreaks in the neonatal ICU: a review of the literature. Curr Opin Infect Dis 2017; 30: 395-403.
6. Chong J, Quach C, Blanchard AC, Poliquin PG, Golding GR, Laferrière C, et al. Molecular epidemiology of a vancomycin-intermediate heteroresistant Staphylococcus epidermidis outbreak in a neonatal intensive care unit. Antimicrob Agents Chemother 2016; 60: 5673-5681.
7. Weßels C, Strommenger B, Klare I, Bender J, Messler S, Mattner F, et al. Emergence and control of linezolid-resistant Staphylococcus epidermidis in an ICU of a German hospital. J Antimicrob Chemother 2018; 73: 1185-1193.
8. Klingenberg C, Ronnestad A, Anderson AS, Abrahamsen TG, Zorman J, Villaruz A, et al. Persistent strains of coagulase-negative staphylococci in a neonatal intensive care unit: virulence factors and invasiveness. Clin Microbiol Infect 2007; 13: 1100-1111.
9. Lazaris A, Coleman DC, Kearns AM, Pichon B, Kinnevey PM, Earls MR, et al. Novel multiresistance cfr plasmids in linezolid-resistant methicillin-resistant Staphylococcus epidermidis and vancomycin-resistant Enterococcus faecium (VRE) from a hospital outbreak: co-location of cfr and optrA in VRE. J Antimicrob Chemother 2017; 72: 3252-3257.
10. Dong Y, Speer CP. The role of Staphylococcus epidermidis in neonatal sepsis: Guarding angel or pathogenic devil? Int J Med Microbiol 2014; 304: 513-520.
11. Alp E, Esel D, Yildiz O, Voss A, Melchers W, Doganay M. Genotypic analysis of Acinetobacter bloodstream infection isolates in a Turkish university hospital. Scand J Infect Dis 2006; 38: 335-340.
12. Wang SH, Sheng WH, Chang YY, Wang LH, Lin HC, Chen ML, et al. Healthcare-associated outbreak due to pan-drug resistant Acinetobacter baumannii in a surgical intensive care unit. J Hosp Infect 2003; 53: 97-102.
13. Hsu J-F, Chu S-M, Lien R, Chiu C-H, Chiang M-C, Fu R-H, et al. Case-control analysis of endemic Acinetobacter baumannii bacteremia in the neonatal intensive care unit. Am J Infect Control 2014; 42: 23-27.
14. Maciel WG, da Silva KE, Croda J, Cayô R, Ramos AC, de Sales RO, et al. Clonal spread of carbapenem-resistant Acinetobacter baumannii in a neonatal intensive care unit. J Hosp Infect 2018; 98: 300-304.
15. Roy S, Basu S, Dasgupta S, Singh AK, Viswanathan R. Carbapenem resistance in Acinetobacter baumannii isolated from blood of neonates with sepsis. Indian J Med Microbiol 2010; 28: 416-417.
16. Ulu-Kilic A, Gundogdu A, Cevahir F, Kilic H, Gunes T, Alp E. An outbreak of bloodstream infection due to extensively resistant Acinetobacter baumannii among neonates. Am J Infect Control 2018; 46: 154-158.
17. Yusef D, Shalakhti T, Awad S, Algharaibeh Ha, Khasawneh W. Clinical characteristics and epidemiology of sepsis in the neonatal intensive care unit in the era of multi-drug resistant organisms: A retrospective review. Pediatr Neonatol 2018; 59: 35-41.
18. Peleg AY, Hooper DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 2010; 362: 1804-1813.
19. Lee H-Y, Hsu S-Y, Hsu J-F, Chen C-L, Wang Y-H, Chiu C-H. Risk factors and molecular epidemiology of Acinetobacter baumannii bacteremia in neonates. J Microbiol Immunol Infect 2017; 51: 367-376.
20. von Dolinger de Brito D, Oliveira EJ, Abdallah VO, da Costa Darini AL, Filho PP. An outbreak of Acinetobacter baumannii septicemia in a neonatal intensive care unit of a university hospital in Brazil. Braz J Infect Dis 2005; 9: 301-309.
21. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36: 309-332.
22. Lee E, Anjum F. Staphylococcus Epidermidis. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563240/
23. Kilic A, Li H, Mellmann A, Basustaoglu AC, Kul M, Senses Z, et al. Acinetobacter septicus sp. nov. association with a nosocomial outbreak of bacteremia in a neonatal intensive care unit. J Clin Microbiol 2008; 46: 902-908.
24. Wang Y, Ren J, Yao Z, Wang W, Wang S, Duan J, et al. Clinical impact and risk factors of intensive care unit-acquired nosocomial infection: a propensity score-matching study from 2018 to 2020 in a teaching Hospital in China. Infect Drug Resist 2023; 16: 569-579.
25. Auriti C, Maccallini A, Di Liso G, Di Ciommo V, Ronchetti MP, Orzalesi M. Risk factors for nosocomial infections in a neonatal intensive-care unit. J Hosp Infect 2003; 53: 25-30.
26. Nagata E, Brito AS, Matsuo T. Nosocomial infections in a neonatal intensive care unit: incidence and risk factors. Am J Infect Control 2002; 30: 26-31.
27. Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet 2005; 365: 1175-1188.
28. Touati A, Achour W, Cherif A, Ben Hmida H, Afif FB, Jabnoun S, et al. Outbreak of Acinetobacter baumannii in a neonatal intensive care unit: antimicrobial susceptibility and genotyping analysis. Ann Epidemiol 2009; 19: 372-378.
29. Chen L-K, Kuo S-C, Chang K-C, Cheng C-C, Yu P-Y, Chang C-H, et al. Clinical antibiotic-resistant Acinetobacter baumannii strains with higher susceptibility to environmental phages than antibiotic-sensitive strains. Sci Rep 2017; 7: 6319.
30. Meyer E, Gastmeier P, Deja M, Schwab F. Antibiotic consumption and resistance: data from Europe and Germany. Int J Med Microbiol 2013; 303: 388-395.
31. Manzoni P, Arisio R, Mostert M, Leonessa M, Farina D, Latino MA, et al. Prophylactic fluconazole is effective in preventing fungal colonization and fungal systemic infections in preterm neonates: a single-center, 6-year, retrospective cohort study. Pediatrics 2006; 117(1): e22-32.
32. Austin N, Cleminson J, Darlow BA, McGuire W. Prophylactic oral/topical non‐absorbed antifungal agents to prevent invasive fungal infection in very low birth weight infants. Cochrane Database Syst Rev 2015; 2015: CD003478.
| Files | ||
| Issue | Vol 15 No 3 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v15i3.12895 | |
| Keywords | ||
| Acinetobacter baumannii; Staphylococcus epidermidis; Outbreak; Neonatal intensive care units; Nosocomial infections | ||
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How to Cite
1.
Nayeri F, Dalili H, Shariat M, Farrokhzad N, Abouhamzeh K, Sahebi L. Epidemiology of nosocomial Staphylococcus epidermidis and Acinetobacter baumannii infections in a neonatal intensive care unit. Iran J Microbiol. 2023;15(3):350-358.
